Healthcare Provider Details

I. General information

NPI: 1447219274
Provider Name (Legal Business Name): JENNIFER M BECKER APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15650 CEDAR AVE
APPLE VALLEY MN
55124-7283
US

IV. Provider business mailing address

520 WHITE PINE WAY
EAGAN MN
55123-4900
US

V. Phone/Fax

Practice location:
  • Phone: 952-997-4100
  • Fax:
Mailing address:
  • Phone: 612-247-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR-137493-9
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1374939
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1374939
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: